Nielsen Suzanne, Hillhouse Maureen, Weiss Roger D, Mooney Larissa, Sharpe Potter Jennifer, Lee Joshua, Gourevitch Marc N, Ling Walter
UCLA Integrated Substance Abuse Programs, Los Angeles, California; University of Sydney, Camperdown, New South Wales, Australia.
Am J Addict. 2014 Jul-Aug;23(4):343-8. doi: 10.1111/j.1521-0391.2013.12105.x. Epub 2013 Sep 24.
This analysis aims to: (1) compare induction experiences among participants who self-reported using one of the four most commonly reported POs, and (2) examine factors associated with difficult bup-nx induction. Our hypothesis, based on previous research and current guidelines, is that those on longer-acting opioids will have experienced more difficult inductions.
The Prescription Opioid Addiction Treatment Study (POATS) was a multi-site, randomized clinical trial, using a two-phase adaptive treatment research design. This analysis examines bup-nx induction of participants who self-reported primary PO use of methadone, ER-oxycodone, IR-oxycodone, and hydrocodone (n = 69). Analyses examined characteristics associated with difficult induction, defined as increased withdrawal symptoms measured by the Clinical Opiate Withdrawal Scale (COWS) after the first bup-nx dose with higher scores denoting greater withdrawal symptoms/severity.
Contrary to our hypothesis, difficult induction experiences did not differ by primary PO type. Those who experienced a post-induction increase in COWS score had lower pre-dose COWS scores compared to those who did not experience a post-induction increase in COWS score (10.09 vs. 12.77, t(624) = -13.56, p < .001). Demographics characteristics, depression, and pain history did not predict a difficult induction.
Difficult bup-nx inductions were not associated with participants' primary PO. Severity of withdrawal, measured with the COWS, was an important variable, reminding clinicians that bup-nx should not be commenced prior to evidence of moderate opioid withdrawal. These findings add to the evidence that with careful procedures, bup-nx can used with few difficulties in PO-dependent patients. (Am J Addict 2014;23:343-348).
本分析旨在：（1）比较自我报告使用四种最常提及的处方阿片类药物之一的参与者的诱导体验，以及（2）研究与丁丙诺啡-纳洛酮诱导困难相关的因素。基于先前的研究和现行指南，我们的假设是，使用长效阿片类药物的人诱导过程会更困难。
处方阿片类药物成瘾治疗研究（POATS）是一项多中心随机临床试验，采用两阶段适应性治疗研究设计。本分析考察了自我报告主要使用美沙酮、缓释羟考酮、即释羟考酮和氢可酮的参与者的丁丙诺啡-纳洛酮诱导情况（n = 69）。分析考察了与诱导困难相关的特征，诱导困难定义为首次服用丁丙诺啡-纳洛酮剂量后，临床阿片类药物戒断量表（COWS）测量的戒断症状增加，分数越高表示戒断症状/严重程度越高。
与我们的假设相反，诱导困难体验在主要处方阿片类药物类型之间没有差异。与诱导后COWS评分未增加的人相比，诱导后COWS评分增加的人给药前COWS评分更低（10.09对12.77，t(624) = -13.56，p <.001）。人口统计学特征、抑郁和疼痛史不能预测诱导困难。
丁丙诺啡-纳洛酮诱导困难与参与者主要使用的处方阿片类药物无关。用COWS测量的戒断严重程度是一个重要变量，提醒临床医生在出现中度阿片类药物戒断证据之前不应开始使用丁丙诺啡-纳洛酮。这些发现进一步证明，通过谨慎的程序，丁丙诺啡-纳洛酮可以在阿片类药物依赖患者中顺利使用。（《美国成瘾杂志》2014年；23:343 - 348）
